Provider Demographics
NPI:1073735296
Name:KISIC, MARIE THERESE (C PED)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:THERESE
Last Name:KISIC
Suffix:
Gender:F
Credentials:C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-3009
Mailing Address - Country:US
Mailing Address - Phone:412-682-2759
Mailing Address - Fax:412-682-3920
Practice Address - Street 1:4313 BUTLER ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15201-3009
Practice Address - Country:US
Practice Address - Phone:412-682-2759
Practice Address - Fax:412-682-3920
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric